H1N1 INFLUENZA
(SWINE FLU) TREATMENT & MANAGEMENT
under
insight
Dr Anas M
Clinical Pharmacist
Kims Al-Shifa Super Speciality
Hospital
Swine Flu
Swine
Flu is highly contagious respiratory disease in pigs caused by one of several
influenza A viruses. Transmission of swine influenza viruses to human is
uncommon. However, the swine influenza virus can be transmitted to humans via
contact with infected pigs or environments contaminated with swine influenza
viruses.
Signs and
Symptoms
Manifestations
of H1N1 influenza are similar to those of seasonal influenza. Patients present
with symptoms of acute respiratory illness, including at least 2 of the
following:
·
Fever
·
Cough
·
Sore
Throat
·
Body
aches
·
Headache
·
Chills
and fatigue
·
Diarrhoea
and Vomiting.
Medication
Summary:
Laboratory
testing had found the H1N1 influenza A (swine flu) virus susceptible to the
prescription antiviral drugs oseltamivir and zanamivir. Other antiviral agents
(eg:amantadine, rimantadine) are not recommended because of recent resistance
to the other influenza strains documented over past several years.
The
usual vaccines for influenza administered at the beginning of the flu season is
not effective for this viral strain. Also other antiviral agents (eg,
amantadine, rimantadine) are not recommended because of recent resistance to
other influenza strains documented over the past several years.
Who Guidelines:
WHO
guidelines recommended treating serious cases immediately. Evidences indicates
that oseltamivir, when properly prescribed, significantly decreases risk of
pneumonia (a leading cause of death for both pandemic and seasonal Influenza)
and the need for hospitalization.
In
the 2009 H1N1 pandemic, oseltamivir-resistant strains were observed in a small
number of patients. Most oseltamivir resistance occurred in severely
immunocompromised patients patients with prior exposure to oseltamivir.
For
patients who initially presents with severe illness or whose condition begins
to deteriorate, initiate oseltamivir as soon as possible. For patients with
severe or deteriorating illness, treatment should be provided even if started
later.
Initiate
antiviral agents within 48 hours
Prompt
initiation of antiviral agents within 48 hours of symptoms onset is imperative
for providing treatment treatment efficacy against influenza virus. In studies
of seasonal influenza, evidence for benefits of treatment is strongest when
treatment is started within 48 hours of illness onset. However some studies of
treatment of seasonal influenza have indicated benefit, including reductions in
mortality or duration of hospitalization, even in patients whom treatment was
started more than 48 hours after illness onset. The recommended duration of
treatment is 5 days.
Paediatric
Considerations
Aspirin
or aspirin-containing products should not be included in the treatment of
confirmed of suspected viral infection in person aged 8 ye or younger because
of the risk of Reye syndrome. For relief of fever, other antipyretic
medications (eg: acetaminophen, nonsteroidal anti-inflammatory drugs) are
recommended.
Pregnant Women
Oseltamivir
and zanamivir are “Pregnancy Category C” medications, indicating that no
clinical studies have been conducted to assess the safety of these medications
in pregnant women. Because of the unknown effects of influenza antiviral drugs
on pregnant women and their foetuses, oseltamivir and zanamivir should be used
during pregnancy only if the potential benefits justifies the potential risk to
the embryo or fetus. However no adverse effects have been reported among women
who received oseltamivir or zanamivir during pregnancy or amonh infants born to
women who have received oseltamivir or zanamivir.
Oseltamivir
Inhibits
neuraminidase, which is a glycoprotein on the surface of the influenza virus
that destroys the infected cells receptor for viral hemagglutinin. By
inhibiting viral neuraminidase, decreases release of viruses from infected
cells and thus virus spread. Effective to treat influenza A or B. Start within
40h of symptom onset. Available as 30mg and 75 mg oral capsule and syrup.
Zanamivir
Inhibits
neuraminidase, which is a glycoprotein on the surface of the influenza virus
that destroys the infected cells receptor for viral hemagglutinin .By
inhibiting viral neuraminidase, release of viruses from infected cells and
viral spread are decreased. Effective against both influenza A and B.
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